The Healthcare System
Frameworks for thinking about the healthcare system
What are the Triple Aim and Iron Triangle
Physicians are traditionally paid using this system
What is the resource-based relative value system (RVU)
Hospitals are traditionally paid using this method
What are Diagnosis Related Groups
Hospitals often use temporary staff in this clinical position.
What are nurses
The difference between Medicare and Medicaid
Medicare insures older people; Medicaid insures poorer people
Aspects of the Iron Triangle
What are Cost Quality and Access
Physicians code procedures using this system
What is Common Procedural Terminology (CPT)
This is a primary reason why hospitals merge
What is bargaining power?
3 (of many) tasks that hospital managers are responsible for
•Task Allocation
•Compliance
•Revenue Cycle and Working Capital Management
•Human Resources
•Hiring
•Performance Management
•Wage-setting
•Logistics/Facilities
•Cost Management
•Operations Management
Negotiations – with whom?
This value-based payment strategy provides one payment for both the physician and the hospital
What are bundled payments
Aspects of the Triple Aim
What are Population Health, Experience of Care, and Per-Capita Cost?
Physicians sometimes compete with these other providers
What are advanced practice providers (or physician extenders) (PA's and NPs)
This is when hospitals use financial gains ("profits") from one department to pay offset losses in another department
What is cross-subsidization
This refers to specific brand of supplies (such as surgical staples) that some physicians may have a preference for and hospitals must stock
What are physician preference items
This entity accredits health care facilities
What is The Joint Commission
Four traditional ways of paying for healthcare
What are:
1. Fee for Service
2. Case rate
3. Per Diem
4. Capitation
This "quality improvment' measure lead to physicians refusing to take on high-risk patients
What are physician report cards
This term refers to the process of treating a patient, billing and collecting money
What is the revenue cycle (or revenue cycle management)
This term refers to patient care that is divided across multiple providers
What is care fragmentation
Two of the three methods hospitals use to determine costs
What are:
1. Ratio of Costs to Charges
2. Activity-Based Costing
3. Time-Driven Activity Based Costing
HIPAA protects provides these three protections
What are:
1. Privacy of health information
2. Security of health information
3. Patient's rights to their health information
Physicians often spend approximately 3% of revenue on this administrative task
What is collecting payments?
Net patient revenue includes everything billed minus these two categories
What are charity care and bad debt
This care model includes providers working together and taking on the risk for a panel of patients
What are accountable care organizations
These guidelines provide standard recommendations for how to care for patients with common characteristics
What are clinical practice guidelines